Compiled by Miles Z. Epstein, Editor, COMMERCE
The benefits of robotic surgery include a faster return to daily activities; fewer complications; shorter hospital stays; reduced hospitalization costs; reduced trauma; significantly less pain; and less scarring. Here are some examples that show how it can enhance the capabilities of trained surgeons to improve quality-of-life for patients and save lives, as well.
Atlantic Health System Morristown Medical Center
By Michael Hernando, M.D., Director of Minimally Invasive and Robotic Surgery
Morristown Medical Center (MMC) is dedicated to offering more minimally invasive surgical options to help patients return to their lives faster. We offer patients the latest technology by a highly experienced surgical team, less downtime and a shorter waiting period to schedule the surgery. We’re also expanding our minimally invasive surgical procedures offered in an outpatient setting. Patients who can benefit from minimally invasive surgeries include surgical oncology, bariatric, general, head and neck, pediatric urologic, transoral, gynecologic and gynecologic oncology, and urologic and urogynecologic. MMC has the latest, state-of-the-art da Vinci® Surgical Systems that give the surgeon added capabilities of which translates to better outcomes for patients, including, in most cases, reduced pain, reduced hospitalization, minimal scarring and a faster recovery. Advances in robotic-assisted laparoscopy, for example, shows a benefit over traditional laparoscopy in areas of the body where the surgeon needs to manipulate instruments within tighter spaces and at tighter angles such as the pelvis for gynecological procedures, or the upper abdomen (esophageal cancer), as well as for urology (prostate surgery) and colorectal surgery (rectal cancer).
Atlantic Health System, Overlook Medical Center
By Paul Starker, M.D., Chair of the Department of Surgery
Robotic surgery, or more accurately, robotic-assisted laparoscopy, helps most in areas of the body where the surgeon encounters tighter spaces and tighter angles. Other robotic-assisted systems are computer-guided, which enhance precision. A great example of computer-guided robotic-assisted surgery is an option for brain surgery that Overlook recently pioneered, the ROSA Brain robot. ROSA Brain is a surgical navigation and positioning system, much like a GPS, uses electrodes to pinpoint exactly which part of the brain is responsible for seizures, without having to surgically remove part of the skull or even shave a patient’s head, as other traditional methods require. The robot also can assist in deep brain stimulation, trans-nasal and ventricular endoscopy and brain biopsies. Another great example is the Mako System, another computer-guided, robotic-arm option that we use at Overlook for partial knee replacements.
The Mako System creates a 3-D, virtual view of the patient’s bone surface and correlates the image to the pre-programmed surgical plan. Mako’s robotic arm then acts as a virtual “assistant” keeping the surgeon’s movements to the pre-planned area of the bone. With more accurate alignment, the implant is expected to last longer, and also preserves more of the patient’s own bone and tissue.
By James McGinty, M.D., Chief of Surgery and Surgical Services
Almost any patient in need of a surgical procedure can benefit from robotic surgery. Englewood Health has been using robotic surgery since 2009, and we have since expanded its use into a variety of procedures including urologic, colorectal, gynecologic, thoracic and general surgery. Robotic surgery enhances the capabilities of a surgeon performing minimally invasive surgery which, compared to conventional open surgery, results in fewer complications, less blood loss, less use of pain medication and decreased length of stay. With a robot, the surgeon is able to perform surgery with greater visual magnification and visibility, better instrument maneuverability than with traditional laparoscopic instruments and more precise maneuvering during very intricate surgery. Because the surgeon is seated at a console in an ergonomically sound position, they have less fatigue. Additionally, the surgeon does not need to rely on an assistant to retract tissue and hold a camera, which streamlines the operation. As a result of these factors, our patients generally feel much better recovering from surgery performed robotically, return home and pick up with their normal routines more quickly and have shorter recovery times.
Hackensack Meridian Health, Hackensack University Medical Center
By Yair David Kissin, M.D., Vice Chair, Department of Orthopedic Surgery
Hackensack University Medical Center, a national leader in orthopedic care and robotic surgery, performed the first total knee replacement surgery in the nation using the TSolution One® Total Knee Application by THINK Surgical, Inc. This is the first surgery since the groundbreaking technology received FDA approval for treating osteoarthritis last year. In January, Hackensack University Medical Center became the first hospital in the country to acquire the TSolution One® surgical system, which offers a more personal and precise surgical experience for orthopedic patients. It was an honor to perform the first total knee replacement surgery in February on Eugenia Dziopa, 64, of Sussex, New Jersey, using this innovative technology. Like many patients, Mrs. Dziopa suffers from severe arthritis in her knee. Alternative forms of treatment did not improve her situation. She is recovering well since surgery and looking forward to spending quality time with her family. As one of five surgeons who participated in the clinical trial that confirmed the safety and efficacy of this technology, I am confident that this solution will be a gamechanger for traditional knee replacements. We look forward to enhancing the quality of life for patients such as Mrs. Dziopa, utilizing the latest advances in robotic technology.
Holy Name Medical Center
By Ari Seidenstein, M.D., Chief of Orthopedic Surgery
Whatever a patient’s age or reason for knee replacement surgery, Holy Name Medical Center offers robotic knee replacement that can shorten the hospital stay, reduce recovery time, and get patients quickly back to what they love to do. Robotic knee replacement surgery is not a one-size-fits-all procedure but personalized to get patients the right fit for their own unique knee. Advanced robot-assisted technology enables the orthopedic surgeon to achieve the proper alignment of the implant so the patient will be comfortable, the knee will be flexible and the implant will be long-lasting. Patients benefit from Holy Name’s comprehensive pre- and post-surgical care. Robot-assisted technology is also used by Holy Name surgeons to perform gynecologic, urologic, and bariatric procedures. The medical center is certified by the Surgical Review Corporation as a Center of Excellence for its performance of outstanding robotic surgery.
Jefferson Health New Jersey
By Roy L. Sandau, D.O., FACOS, Chief of Surgery
Robotic-assisted surgery (RAS) allows surgeons to perform delicate and complex operations through tiny incisions with enhanced ergonomics, vision, precision, dexterity and control. Patients, surgeons and hospital systems recognize several advantages of RAS, which include reduced blood loss, narcotic use, recovery time and return to normal activities. A very exciting advancement in RAS is the development of image overlay navigation technology. Radiologic imaging and fluorescence now can be superimposed over the patient’s anatomy to help guide the surgeon to localize and remove cancerous tumors and metastatic lymph nodes, as well as accurately place prosthetic implants in orthopedic joint and spine surgery. For all the above reasons, RAS has grown to include all of the major cancer surgery specialties; colorectal, gynecology, hepatopancreaticobiliary, otolaryngology, thoracic, urology and even breast surgery. It is quickly growing in the neuromusculoskeletal specialties, including neurosurgery, orthopedic, and plastic and reconstructive surgery. The fastest-growing field is general surgery, with hernia and bariatric surgery leading the way. With more than 10 major medical companies developing surgical operating systems, it is no surprise, more and more, patients are questioning whether their surgery can be done robotically.
RWJBarnabas Health, Newark Beth Israel Medical Center
By Adam M. Kopelan, M.D., FACS, Chairman, Department of Surgery
At Newark Beth Israel, we have performed more than 2,000 robotic-assisted surgeries in the past decade and a half, and have become very familiar with how to maximize the technological advances and translate this experience to big wins for our patients. It’s part of our belief that minimally invasive surgery should be the standard of care whenever possible, because it’s safer for most patients. The robotic surgery platform allows us to achieve the goal of minimally invasive surgery across multiple patients in the all of the disciplines of surgery. There are additional benefits: less pain; smaller incisions; less blood loss; less risk for infection; faster recovery and shorter hospital stays to name several. We were one of the earliest programs in the United States to offer many robotic surgery options for our patients. Currently our surgeons in urology, gynecology, thoracic surgery and general/oncologic surgery perform procedures such as prostate removal, hysterectomy, lung resection, colorectal resection and hernia repair. An example of our programmatic commitment and investment in talent and resources is highlighted by our being able to do one of the most complex procedures in pancreatic cancer surgery, the Whipple procedure.
RWJBarnabas Health, Rutgers Cancer Institute of New Jersey
By Aliza Leiser, M.D., FACOG, Interim Division Director, Division of Gynecologic Oncology
Robotic surgery has found a significant role in minimally invasive surgery for many patients with gynecologic cancers and is included in the treatment arsenal as part of the Gynecologic Oncology Program at Rutgers Cancer Institute of New Jersey and Robert Wood Johnson University Hospital, New Brunswick, an RWJBarnabas health facility. This includes the management of patients with early stage endometrial cancer. In these cases, a number of studies have shown advantages with regards to blood loss, transfusion requirements, conversion to laparotomy, operative time and length of hospital stay. It is also important to know that removing sentinel lymph nodes through robotic surgery in patients with endometrial cancer has become a widely accepted technique and is often recommended by the surgeon. Other gynecologic cancers have emerging indications for the use of robotic surgery, from early stage ovarian cancers amenable to laparoscopic techniques all the way to more complex procedures involving the removal of pelvic organs. It is important to also know that laparoscopic techniques have fallen out of favor for many cervical cancer patients requiring surgery, and patients should have an in-depth discussion about this with their surgeons.
RWJBarnabas Health, Saint Barnabas Medical Center
By Thad Denehy, M.D., Gynecologic Oncologist
At Saint Barnabas Medical Center (SBMC) many patients are eligible and may benefit from the use of the daVinci® Robotic Surgical Systems including those requiring advanced, minimally invasive gastrointestinal, thoracic, gynecologic or urologic surgery. I use the daVinci Robotic Surgical System for 70 percent of the surgery that I performs. Using the robot-assisted system, we are able to perform surgery using a few small incisions, instead of a larger incision. Recent advances in the area of gynecologic oncology couple utilizing the daVinci Robotic Surgical System with the use of firefly technology for sentinel node identification. The system is designed to help surgeons perform surgery through the control of specialized instruments and a miniaturized camera, resulting in shorter recovery times, less risk of infection, scarring and pain for patients and faster return to normal activities.
Saint Peter’s University Hospital
By Andrew Camerota, M.D.,General, Laparoscopic and Robotic Surgery
Robot-assisted surgery offers the ability to perform complex procedures with unmatched precision. For the patient, it offers multiple benefits including less scarring, less blood loss, significantly less pain and a shorter recovery time. Common operations that can be performed using robotics are gallbladder removal, hernia repair, colon and other bowel removal, anti-reflux procedures, hysterectomy and prostate resection. It’s important to emphasize that robotic abdominal surgery is 100 percent controlled by the surgeon. Patients often think that robotic surgery means the physician is less involved, but not only does robotic surgery require the physician to have special training, it allows them more precision and control during the procedure. Patient benefits include increased mobility which contributes to a patient’s ability to resume normal daily activities sooner. Instead of waiting weeks to return to work and exercise, it’s often days. Robotic surgery also reduces the need for narcotics, all of which lead to an improved quality of life for the patient. I see less need for recurring surgeries for such cases as hiatal hernia repair if done robotically. Suturing and dissection are easier with robot-assisted surgeries and, as a result, I’m confident that the future of medicine will include more surgeries performed with the use of robotics.
St. Joseph’s Health, St. Joseph’s University Medical Center
By Brian Day, M.D., FACOG, Passaic Valley OB/GYN
At. St. Joseph’s University Medical Center, our expert gynecologic surgeons are skilled in the use of minimally invasive and robotic surgery techniques, offering women new treatment alternatives to some very common conditions. Using a robotic-assisted system can allow for a greater range of motion of the instruments and a three-dimensional vision of the area of surgery. Because the movement of instruments by the robot is gentler than a human hand, there is less bruising and stretching of skin (especially for difficult-to-treat gynecologic conditions), allowing for greater precision and less pain after surgery. These advancements in robotic-assisted, minimally invasive surgery have allowed us to offer new treatment options to more and more women. Women who were not always candidates for surgery now have options that can dramatically preserve their health and improve their lives. The most common procedures I perform robotically are hysterectomies, myomectomy (the removal of fibroids from the uterus) and surgical management of endometriosis. Before the advancements of robotic surgery, these procedures often meant significant discomfort and weeks of recovery. In the past, surgery for conditions such as fibroids or endometriosis typically required large incisions, lengthy hospital stays and long recoveries. However, with robotic procedures, patients may stay only one night in the hospital and are back to their normal routines within two weeks.
The Valley Hospital
By Howard H. Jones, M.D., Subspecialty Director, Minimally Invasive and Robotic Surgery; Director, Minimally Invasive Gynecologic Surgery, Valley Medical Group.
Thanks to high-definition 3-D visualization tools, personalized surgical plans, intuitive motion and ergonomic design, robotic surgery enables surgeons to perform even the most complex and delicate procedures through very small incisions with outstanding precision. Robotic surgery offers several advantages over open surgery, including significantly less pain, reduced blood loss, less scarring, a shorter recovery time, a faster return to normal daily activities and, in many cases, better clinical outcomes. Early recovery is especially important for patients undergoing cancer treatment, as it may mean an earlier transition to the next stage of treatment.
In 2001, Valley was among the first hospitals in the country to adopt the first da Vinci® Surgical System for minimally invasive surgeries. Valley continues to invest in next-generation robotic systems—including the da Vinci Xi® Surgical System and the Mako Robotic-Arm Assisted Surgical System for partial knee, total knee and hip replacements—to bring the latest minimally invasive options to patients. Valley’s surgeons receive extensive training in robotic surgery techniques. Through the use of robotic surgery, Valley surgeons can offer a minimally invasive alternative to complex open surgeries. This technique allows surgeons to operate through the smallest of incisions, offers greater precision and brings significant benefits to patients.
Trinitas Regional Medical Center
By Sergio Baerga, M.D., Director of Robotic Surgery
Thanks to using robots in the operating room, surgery that once required large incisions (and unsightly scars) can now be performed through smaller, single-site entries. Cases that require precise, fine dissection and laparoscopic suturing are prime candidates for robotic surgery, which means blood loss during surgery is reduced and, therefore, discomfort is minimalized. Patients in need of general surgery can benefit, as well as surgery for reproductive issues such as endometriosis, cardiology, endocrinology, and conditions related to aggressive cancers of the bladder, uterus, prostate and throat. There have been many developments in robotic surgery, for instance, Transoral Robotic Surgery (TORS), a minimally invasive procedure used to treat oropharynx cancers. TORS often eliminates the need for large incisions and division of the jawbone that are sometimes required by traditional surgery. The system not only allows for greater dexterity but also great visibility—up to 10 times stronger magnification—than traditional surgical procedures. And if a second surgeon is needed, there’s no need for that doctor to scrub in; they can simply sit down at an adjoining console to access the surgical field.